Registration Form Children’s Musical Theatre Workshop Celebrating Canada’s 150th Birthday All workshops take place at St. Paul High School

Child’s Information: Child’s First Name:

Grade:

Child’s Last Name: Date of Birth (yy/mm/dd):

Male

Female

School Name: Home Address: City:

Postal Code:

Home Phone: Does your child carry an Epi-Pen? Yes No Please list allergies or any medical information we should be aware of: ____________________________________________________________________________________ ____________________________________________________________________________________ Parent/Guardian Information: Name of parent/guardian (1): Phone (Home):

Phone (Work):

Name of parent/guardian (2): Phone (Home):

Phone (Work):

Email address: Please mail or drop off your completed form with payment to: Ottawa Catholic School Board, Attention: Continuing Education Department 570 West Hunt Club Road, Nepean, ON K2G 3R4 Cheque

Money Order

Interac/Cash (in person only)

Do you give permission to the Catholic Education Foundation of Ottawa (CEFO) and the Ottawa Catholic School Board to email you regarding program details? Yes

No Signature of Parent/Guardian: ____________________________________